sir:
i am a vietnam veteran that has been diagnosed with bi-polar disorder and
p.t.s.d.this determination was made by at least 2 different pyschiatrists (board
certified) from the veterans administration. as a child, in my opinion, my
mental health was normal. i had the normal childhood problems (i was picked on a
little, lost a couple of girlfriends, family deaths, e.t.c.), but overall,
nothing out of the ordinary. my mother would have probably noticed any unusual
behavior, as she was a highly educated woman (she had her own small layman
medical library ). my question is, can p.t.s.d. be a trigger for bipolar
disorder? i did not start having real problems until approximately 4 months
after returning stateside from s. e. asia. apparently, this when the p.t.s.d.
component kicked in. i am curious to know how and when the bipolar disorder
component is possibly triggered. anyway, i await your answer. if you require any
more input, please tell me.

Dear Mr. F.' --

Unfortunately, yours is a very relevant question these days. You could have PTSD
alone, with no bipolar disorder, as the two conditions have considerable overlap
and are difficult to distinguish from one another at some times. Or, you might
have both. But why, you ask, if you do indeed have bipolar disorder, might it
have been triggered by getting PTSD from your combat experience in Vietnam?

In this attempt to answer your question, I am quoting from an expert at the
Massachusetts General Hospital (affiliated with Harvard University), Dr. Michael
Otto. He has specialized in the interaction between these two conditions, PTSD
and bipolar disorder. He notes that each can make the other worse. For example,
the nightmares and resulting sleep disturbance of PTSD can make bipolar disorder
much worse, because we know that sleep deprivation is associated with the
development of manic-side symptoms. Sometimes, depressive phases can be caused
by going into a manic phase, so that now we have PTSD, through sleep
deprivation, causing both manic and depressive symptoms.

Similarly, the "hypervigilance" which is characteristic of PTSD, creates a state
of "autonomic hyperarousal", meaning a hormonal environment which is suited for
"fight or flight". This stress condition can lead, in some people, to a
worsening of mood symptoms.

On top of all this, there seems to be some evidence
suggesting that people who will develop PTSD in response to exposure to
life-threatening conditions such as combat are genetically different than those
who do not, at least in part. There is also a "environmental" component,
superimposed on this apparent genetic difference (meaning that the genetic risk
has been modified by life experience somewhere between birth and the trauma
exposure). In other words, there is some sort of susceptibility factor for PTSD
over and above the trauma exposure. Much of this susceptibility factor is
completely outside the control of the person who carries it, because it was
either purely genetic or a genetic factor modified by early childhood
experience, most likely.

There is just a hint of evidence to suggest that this susceptibility factor has
some connection to severe mood disorders such as bipolar disorder. However, the
mechanism of this factor, and how it might be triggered by severe stress,
remains largely understood.

On the other hand, you might be impressed at how much we actually do know about
the mechanism of mood problems. For a detailed explanation of this interplay
between genetic and environmental factors, written in 10th grade English; which
includes a discussion of the way in which stress hormones are thought to affect
mood problems; see the essay on my website about the Brain
Chemistry Of Depression.

To connect all of this discussion to your personal experience, the only clue
about "bipolar" susceptibility in your story, and this is really using a fine
toothed comb, is your comment about your mother's level of education. It is
common for people with a family history of bipolar disorder to have relatives
who are quite brilliant, often outstanding in their fields, and even pursuing
several different fields of interest simultaneously, often very effectively. Not
that we could conclude anything like this about your mother based on your one
line about her in your note, but it did catch my eye. Good luck with your
continued education and recovery.